965 Ticonderoga Tr : • CITY OF EAGAN ~ •
~ 383~ Pilot Knob Road, P.O. Box 21-188, Eagan, MN 55121 ~
PH O N E: 454-8100
BUILDING PERMIT Receipt#
To be,used for Est. Value ~ ~ ' ` ~ Date ~ - ,19 '
Site Addresa' ~ OFFICE USE ONLY
On Site Sewage ~ Occupancy
LOt_~BIoCk Sec/Sub. MWCC System _ Zoning
PBfCeI NO. ` On Site Well _ Type of Const
City Water ~ (Actuaq
a Name (Allowable)
W ~ of Stories
3 Address ' Length
~ City Phone ' ' ' ' ~ Depth
S.F. Total
, p Name Footprint S.F.
~ ~ Address APPROVALS FEES
~ City Phone Assessments _ Permit
Water/Sewer Surcharge
~ W Neme Police _ Plan Review
= n Address Fire _ SAC, City
v Engr. _ SAC, MWCC
~ W City Phone Planner _ Water Conn.
Council _ Water Meter •
I hereby acknowledge that I have reed this application and state B~da ~ff• - Road Unit
that the iMormatlon is Conect and agree to complywith all appliceble A~ - Treatment P1
Stete of Minnesota Statutes and Cfty of Eagan Ordinances. Varlance _ Parks
Copies
Signature of Permittee TOTAL
A Building Permit is issued to: ~ on the express condition that
all work ahall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Officiel
Permit No. Permit Holder Date Telephons ~
?~umbing ~~-~f~~,~ . ~~~~~~z . ~ ~~7
H.V.AC. Jr' ~ ,y/~~,
E~ectric 7'a0/ ~~~C~ ~r ~,/~y~~~ %~.CO
Softener ; ,C~' ~ L ,5'~~-~8 7 '~`~S
Inspection Dat~ Insp. Comments
Footings I ~
FOOtings II
Foundation
Framing C'vr~c~='f'~~.,~ Y-sY-P7 ~r.
Roofing ~
Rough Plbg. ~ _ ~j•
Rough Htg. N 3~~
~su~. y~l /Y •
Fireplace
Finat Htg. ~
Final Plbg.
Bldg. Final
Cert.Occ. ~ ~
Temp. LP
Deck Ftg.
Deck Frmg.
Well
Pr. Disp.
l~` , _ _
PERMIT # ' ` ~
' , MECHANICAL PERMIT '"'i ; ~ ~
~ ~ CITY OF EAGAN RECEIPT # ~ ~ ` ~ ~
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE ~~~~s ~
CONTRACT PRICE: PHONE: 454-8100
~ite Address BLDG. TYPE WORK ~ESCRIPTION
Lot~~_Block ~ Sec/Sub
_ ` ~ Res. ~ New L-
, ~
~ Mult Add-on
m ~8me F ~ Comm. " Fiepair
Address; ~ ~
c City Phone / ' ~ ~er
FEES
~ Name RES. HVAC 0-100 M BTU -$24.00
c Address ADDITIONAL 50 M BTU - 6.00
p City ~ = ~ ' . Phone ~ ~ l " (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA.
TYPE OF WORK K~ ~ APTABLDGSFE COMM. RA E APUES EE
Forced A~ir ~ fiA ~TU ~ TOWNHOUSE 8 CONDOS RES. RATE APPtIES -
Boiler M'BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .Sp
Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # ~ ~ • ~ BEYOND $1,000)
Other
FEE '
!
S/C: SIGNATURE OF PERMITTEE ~
TOTAL• • ' ~
FOR: CITY OF EAGAN
, . .a_ . ~
. - _ . ,,,...r . , . .
' ~ ' PERMIT # S~{ ~
' ' PLUMBING PERMIT RECEIPT # ~
~ CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55t22 DATE:
CONTRACT PRICE PHONE: 454-8100
Site Rddress ' r BLDG. TYPE WORK DESCRIPTION
Lot Block SeclSub Res. ~ New
- i ~ ~ Muit. Add-on
~ Name ~~+-~(r~~ ~ J~ ` Comm. Repair
~v Address ~ ~ ather
~ City % Phone ~ RES. PLBG. ONLY - COMPLETE THE FQLLOWING:
- NO. FIXTURES TOTAL
Name ~ -~~later Closet - $3.00 '
~ 4 ~ ~Bath Tubs - $3.00 ~ ~
; Address - ~_Lavatory - $3.00 3 -
p Ciry ' ~ Phone ~3 Shower - $3.00
~-Ki!chen Sink - $3.00 y'~ '
FEES Urinal/Bidet - ~3.00
COMM/IND FEE - 1% OF CONTRACT FEE ~_Laundry Tray -$3.00
APT. BLDGS - COMM RATE APPLIES -~Floor Drains -$t.50
TOWNHOUSE 8~ CONDO - RES. RATE APPUES ~_Water Heater -$1.50
M1N4MUM - RESIDENTVAL FEE - $12.00 Wh~ripool - $3.00
MINIMUM - COMM/IND FEE -$20.00 ~-Gas Piping Outlets -$1.50 1.
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT)
(AOD $.50 S/C IF PERMIT PRICE GOES Softener -$5.~0
BEYOND $1,000.00} We11 - $10.00
Private Disp. - $10.00
~~Rough apenings - $1.5~
SIGNATURE OF P E#MITTEE FEE: 2•~~~
' STATE S/C: ' n
FOR: CITY OF EAGAN GRAND TOTAL:
z
s_~ . s~v
~ii4 ~ ?
~~rfif ir~#~ ~f (~rru~~nr~
~
r ~L.itp of ~agan
~r}~~r#nt~ttl af ~itt~ld'ttcg ~Prii~mt
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying ~hat a1 the time of issuance this structure x~rs in compliance with the various
ordinances of the City regulating bailding consrruction or use. For the following.•
u~e cae+dfic.tion i"z'~'`-~ ` Permit Mo. i~iC: 1 S
oecu~ncr Tyx :1 Zoo;,g niatri~x F' 1 Type comc v
o~~e~m~g '-E~ t:(JSICI~S }~3°r~' ~ ~X 1049~ B`VIIS~
~ 6~ "t ~_~X.~?~f'~+"~ ~ r: . I i , H3. IEXi"~ICN 9C~A1~,E 4?]?
~ty
.TIR~ 5, 1967
e~ae~g o~.i
POST IN A CONSPICUOUS PLACE
^ . ,
Dat~ 4~15-?7
CITY OF E~~AN P'ermit Na ~
Sixe:
3830 °iot Knob Road Meter No: ~ ~ Date: '
P.Q Box 211~9 Reader Na .
E~g~i, MN 55121 '
' rtru ~ustor- ~io•;,e.s
r_~ Lexin~ton ~q -
~Wne~ 9~5 Ticondero~-,a Trai L 1
Site Address: zth~ ; ;echan ical
Piumber ~ a F1
~ r ` l~pd ~~}~tiliti~l
Conn. Chg: ir, .{~I~QC~ o f~• i1~~
Acct Dep: 10 0~~~~ ~uar«~:- ELECTCti~ - GAS Etc.
Permit Fee: h the C an
.SFJ d T~ ~~v la r
SurChB~g~ c . .~`~D~= fi~~, V1~
Tr. Plant t ~
Meter. By
Misc.:
, WATER SERVICE PERMIT
L . _ - ;
. . . _ 4-15-~7
. _ pate:
CIT7 ~F-~~"AN PermK No: Size:
DaRe:
3830 Pllot Knob R°ad Re
der No:
P.O. Box 21199
MN 55121 y~;
Ea9an~ ~ ~trc~ ::ustor: :i~raes ~ ~._i ~,e:-izi~ton .~n
~EroQa ra
Owner. ~ con
Site Address: .TOrthx~a :`eC`ianical rl
Plumber Zoning: l
5?.5.0:~ p
Conn. Chg: 1~ No. of Unlts:
Acct. Dep: ln . ,d ~ wlth the C~h? ~ E°9an
Permit Fee: ~ ~ ~ agres to comp Y
Surcharge: 1 Js J. ~Q Ordinances•
Tr. Plant ~
Meter. BY
Misc.: ~
WATER SERVICE PERMI
' SEW ER SERYICE PERMIT
Cl~lf OF C.~GAN r1 7~~
3830 PIlo1 Knob Road PERMIT NO.: ~ -
~ P.O. Bux 2~~99 DATE:
; Eagan, MN 551?~ No. of Units:
Zoning: stom omes
etro
~ Owner. ~x ~ dn ~ q
Addresa con~ eroga r8
Site Address: yo~ ~p ..ec an ca
~ Plumber. - ~ 525.~~Fd
w~ ~~ry o1 Eaqan Connectian Charge: 15 . dOpd _
I 1 agree to canPh? Account DePosit: . c)Opd '
Ordlnanee~. permit Fee: . 5~?P~j
Surcharge:
I Misc. Charges: ~
By Total: ~
I pate of Insp•: p~ paid: y
Insp.:
Tgis re9uest voin /~L~//.t~,~~~ 7~ f
7G
~'-aonths'tyG. ~ ~5I5~~/~ ~ '7~.3! / 8~
C ' ,9 .L ~ ~ ~j~.GG
Heq st De iire No. flouPh-in In U~clion
fleq red? ~j ~Reatly Now ~ Will Notify inspec-
~ yeg ~ No ~ lor When Neady
~icensad Elecnfcal Contracxor ~ S~
1 hereby requast inapec~~on oi ~ov~
Owner electrical work instelleE at: .~5`r
Sv¢et Atldress, Boz or Poute No. Ciry
~ Co dero ar ct a v1
ection o. Townshi0 Name or No. - Nange No. County( /~~p
LQ ~DTK~
OccuD' ~ WRINT) P~one Ne.
~-~~d c~
Power Suoolier - Address ~
a~OfG~ /e ~b0
Electri al Convactor ICompany Na el Convar,mr's License No. ~
l~/~cdlatid E~e~ ~~b~v -
Mailinp Address IContwctor or Owner Making Instaiiaeion)
.~oo W ' ~d ~~Yhsvr
Aut~orize' ie~atur ICOnUaclor/ ner Makine ~~stalla~ion Phone Number
+r~~-~ 0 - 6 G/
M~NNESOTq STATE BOANU OF ELECTAICITY THIS INSPECT~ON REQUEST WILL NOT
~~~9es-Mltlway Bidq. - Room N•181 BE ACCEPTED BY THE STATE BOARD
UNLESS PNOPEN INSPECTION FEE IS
1821 Univerai~vAVe.. 8t Peul, MN 55104
Phone16121642-0600 ENCLOSED.
,r~~~j~ 7 REQUEST FOH ELECTRICAL INSPECTION EB-OODOb05
1 See inslruetions lor completing this lorm on back of vellow copv. 7~~'~'7gG
. " "X" 8e1ow Wak Covered by This Reques! 73uv~
AAd RaD• Type ol B~ilGing APF~iencea Wi~ed EquiVmenl Wired
Home - Range Temporary Service
Duplex Water Heater Lightiny Fixtures ~
Apt. BuilAinc~ Dryer Electric Meatin
Commercial Bidg. Furnace Silo Unloader
Industrial BIAg. Air Conditioner 8ulk Milk Tank
Farm otner oew v O~herlsuaclbl
~ er ueci Y ~~er Other
nmpute Inspectian Fee Below
k Fee Se•~ieeEntraneeSize N .Fee Fanders~SUbfeedera k Fee Circuits
OtoZ00Am s Oto30Am s Oto30Am
Above 200 qm~zs 37 to 100 Amps 31 to 700 q
Swimming Pool Above 100-Am s A6ove 100_Amps
Transfortriers rrigation Booms Partia6'Othar Fee
Signs Special Inspection 5 ~ TOTA ;1
Remarks . ~ ~-(Jy.~.
~~O
Rough-in e I, th Ela cel
~ ~i~ InspecWq ~e~aby
carli/y Ihet ihe ebove
Final inspaction Ms been
~ made.
T~la repuesl vMC 16 maniM hom ~
TorA~L s ~.sz~
,
CITY OF EAGAN N_ 13 415
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454•8100
BUILDING PERMIT Receipt# ',~-I~S~
Tobeusedfor SF DW6/GAR Est.Value ~67,000 Oate APRIL 2 19 87
Site Address ~ 965 TICONDERDGA TR OFFICE USE ONLY
11 3 LEXINGTON On Site Sewage Occupancy R3
Lot BloCk Sec/Sub. MWCCSystem Zoning R1
Parcel No. SQUARE 4TH - On Site Well 7ype of Conat
City Wa[er (Ac~ual) V
a Name METRO CUSTOM HOMES INC (Allowable) V
w # of Storiea
z Address P•0. BOX 1049 ~y---
Leng[h
a City B'VILLE phone 454-9383 Depth
S.F. Total
, o Name SAME Footprints.F.
ou Address APPROVALS FEES
~a
~ City Phone Assessments Permit $ 3$$.00
F Water/Sewer _ Surcharge -~50
w W Neflle Police _ Plan Review 19~V.00
! s Fire SAC, City
i- Address -
Engc _ SqC, MWCC ~00
aW City Phone Planner _ WaterConn. 575.Op
Council _ WaterMeter 67_00
I hereby acknowledge that I have read this application and state Bldg. Off. _ Road Unit 3(15 .(]p
thattheinformationlscovectandagreetocomplywithallapplicable A~ - TreafinentPt 180.00
State of Minnesota Statutes a City of gan Ordinancas. Variance _ Parks
Copies
Signature of Permittee 70TAL $~~~50
A Building Permit is issued to: ME RO CliSTOM HOMES INC on the express condition that
all work shall be done in accordance with all ap~pli l`e State of M' nesota Statutes and City of Eagan Ordinances.
BuildingOtticial 6q,~-c
~ o ~-p~
"fi
r / 3 _
/ ~ ~
1987 BQILDIAG PEAMIT APPLIC9TION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLQDE 2 SEfS OF PLANS~ 3 CERTIEICATBS OF SQRVEY~ 7 SET OF ENERGY C9LCOLATIONS
NOTE: ADDRESSES FOR CORNEE LOTS - CONTRACTOR/HOMEOANEE MOST ?ESIGHAYE WHICH ADDRESS
IS DESIRED. NO CHANGSS WILL BE ALLOWED DNCE BDILDING PEAMIT IS ISSDSD.
MQLRIPLE DiiELLINGS - RFSIDENTIAL RENTAL QNITS FOR SALE OHITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SORVEY - CfiECg WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
CO~RCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS~
$2~000 LANDSCAPE BOND
61,~
To Be Used For:Sinq~e Fami~U Valuation: Date: t/-~-$7
r-
Site Address q(„5 Ticon~leroaR / OFFICB IISE ONLY
Lot Block 3~ On Site Sewage Oecupancy }2• 3
MWCC System ? Zoning R•I
Parcel/Sub f gyl YlA~0Y1 Sk~IAY'e ~~{~-I~. On Site Well Type of Const
City Water ? (Actual) ~
ow~er YY1e+ro Csstom I~omes,Tl1~_ - (Allowable)
p 41 of Stories
Address Q 0. UbX ~0~ Q Length ~
Depth 4-7
City/Zip Code F~urnsuille 55337 S.F. Total
Footprint S.F.
Phone 45U-9383 APPROVAGS FE~S
Contractor 5 q~ QJ Assessments Permit 38g.
Water/Sewer Surcharge 33.~
Address Police Plan Review
Fire SAC, City DO.
City/Zip Code Engr SAC, MWCC 525
Planner Water Conn ~ 25.
Phone Council Water Meter (v"7.
Bldg Off Road Unit "~5.
Arch. /Engr. 513rr~ APC Treatment Pl ~ S~_
Variance Parks
Address Copies
rar~. 3 / 7. O
City/Zip Code
Phone I!
z r. d
~ _
j(~C~O X • r ~p°~c~ `
~ C~ O ~ i Z = ~~Z~
~C~ x 22 ~
LI k ~ ~ 2_ O x~~- ° v
~OU
~
BcoK. 68~ Par~ ~j
ee !ME'~Zn C'uSTcm ~;cm~ ,
nOpG CCfHSi1lTIH6 E3t61HEf95.
ENGiNE~~i1NG PIANHE9S nnd IAHD SUBVEYC!!S
COMPANY, INC. ~4
< t000 [AST 1451l1 S7RE~T, BURNSVILLE, 1AIHHE:4TJ1 ~:331 P!i ~32'SOOA
CGT~Z~Z CLL~E S?~L+~"'7/'B C~
cr~p~io~z: cor ii, ~(.ocx 3, cExiN6To,~ ~~v~;~~ 4~n~ ~~~~T;.~:.i
~gy~,s~ D4KOTq ~GUN7Y , n7l~VNESOTq
s
` ~89 L~~ sr)a ,
~ ~i s /~h 38 tts.
~ / ~
~ ~ 6O
~3 ~ z'~ / ~y s9Z_o~
, ~ b / ~ C92.o~
~~Z.~ ~ ~ ~
g92.~ s~G? I / ~ i" ~ I5 DRAlNA66 AND
' ~ ~-J L- .J I UTlL17Y •~AS~MENT
S I L'? I l/ I 5CRl6 = 30'
( ~ ~ I C~~S,-5~ Cc:vOrE~ EKr5Tf1~'G ELEVA •'r~~v
I l w r'. <e~?,s~ DE.-VDTES PR..^Po~ED ELEVATIOnr
~ 111 I ~E9Y~.c~ CB96.o~ I n~~
i~ ~n.oo Cssb.-n S.E.W, o. C~S._e'~ I ~ h /NGICATES D/REC i!ON' 0~ ,yUn
Fi~c
~ o ao.oo I ~ ~ ~ DRAi~.iA6cr
~ ' o I PRaoo~~
~ p ° ilflu~ °o ~ p ~
~ N ti ~as~,s~ I~ j 899.8~ = F/N/S.<r'F~ 6RRFoc FLOO,~
~ l ~ iaso ~s9~y' -~i Ei.E1/,aT,'C~v'
`J <
I.~§98.1~ 4°. r--__9.00
~ ~99,Si 4.So I ~
I I o 6F~RA6E ° ~
~y ~ N
~ ` 30.00 /6.~
1~85 ~8~J.83 ~v~b_~) .
5'I ~50 ~~9'~I5' FRD.VT B<//LOlN6
I ~ ~ ~ . SETBACK L /NE
~898.5~ L- - '~97, ~
~&78.6~ ~ ~897.6~
75-00
a N B9° ¢3' a3" W
0
H
N
(898.%~ TlCON
~ 7XA/G, ~~--°~1 -
9~ f
I hereby cartify that thia ia a t:ue and carrect npr=aentatioe o! a trmc! of
lan~ as ihown'and deacribed herean.• An prapartd by mn oa thfa %'r 'day ot
/fPle/~ ~ 19 B7 •
Hinn. Eea._No~~~o~
~C,
~ 0~0 ~o~~
~ ***~**#**+**i****?#f!#i**i*t~##!**i~*.
• ~ CITY OF E~GAi~ » ~
* aprxov~u. oF Pmrsr. ~
APPLICATION FOR PERMIT * *
* nvsnncizor~ oF s~ nr~/~ Fm~ ;
. *f TntSTAT.TA'PTONS WILL NO'P BE SQ'IFD-
SEWER AND/OR WATER CONNECTION P~T ~
' * APPROVID. *
r
s *
, ~ r
r
* *~:+r+++,t,t* * ~wi **r *w::::3*:*:+r+w**~r
P ease Print
~ 1) PROPERTY ADDRESS: 965 Ticonderoga Trail
LEGAL DESCRIPTION: Lot 11 Block 3 Lexington Square Addition 4th
Lot Block Sub ivision or Tax Parce ID )
IF E~QSTING S^IRL'CiL'RE, DATE OF ORIGINAL BL'ILDIN3 PII2MIT ISS[.`ANCE: .
(Nbn Year1
PRFSENP ZONII~G/PROPOSID C'SE:
~ CO„'P']ERCIAL/T2ETAIL/OFFZCE . ~ R-1 SINGLE FAMILY
Q IAIDCSTRIAL Q R-2 DL'PLEX Units)
~ INSTI'iL'TIONAL/GOVERt~r ~ R-3 'IOW[~iOLSE (Three + Units) ( C~nits)
~ R-4 APARTN~Pf/COIvUOMINIC~1 ( Units)
2) ~
Northrup Mechanical Inc.
ADDRESS: 7640 146th Street -
CITY, STATE, ZIP: Apple Valley, MN 55124
432-0175
31 ' For City C~se .
NAME: Northrup Mechanical Inc. Plim~bers License:
ADDRESS: 7640 146th Street
~ ~pirecl
CITY, STATE, ZIP: Apple VaTley, MN 55124 ~~pr~
PHONE: 432-0175 MASTER LICENSE# 2443M ~t
~
4) •s • ~ i~-
NAP~: Metro Home Build~rs
ADDRESS: PO Box 1049 '
CITY. STATE. ZIP: Burnsville, MN 55337
PH01~: 454=9383 •
' •5) n r. :a •a• - a~
~ COI~JC.TION 2V CITY SES~R ~ OOIaIDGPSON TO QTY WATER 0't4~1E[t '
6) r ~ PLF.ASE HOID APPROVID PERMIT FC)R PICK-UP BY ONE OF ABOVE
~ PLEASE MAIL APPROVF.D PF1iMIT 10 1, Q2 3. 4. ABOVE
(Circle one) ~
7) r u" ~~3
- r, ~ r r a r e . ~ • ~ • e - e • a ~a• . . . . • ~ ~
e ~r. s~ • t : ••r. •.Nar i ~ ~ a• • - ~ .
. ~OR CITY IJSE OtVLY
PERMIT # ISSC~ED
;l 1i
Pd w/Bldq, Permit FEES: '
$ S /C " S`-l SEWER PERMIT (INCLC'DE SORCHARGE)
S $ S~ WATER PERMIT (INCLUDE SCRCHARGE) .
$ C ~~U~ $ WATER METER/COPPERHORN/OL'TSIDE READER
S S WATER TAP (INCLC'DE CORPORATION STOP)
$ $ SEWER TAP
$ $ ~ ACCOQNT DEPOSIT - SEWER
$ $ ACCOL'NT DEPOSIT - WATER
$ ~ C.~ ti S /.S^ L~b WAC
s ~ 5
~ cr~ ~ /'.5~ ~ sAc
$ $ TRLNK WATER ASSESSMENT
$ $ TRL~NK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRL'NK SEWER
$ S LATERAL fiENEFIT/TRC~NK WATER
6 C) $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ ~ ~~Z •-C~Z~ $ ' lJ D TOTAL
_ Z ~ 7~~C~~
RECEIPT RECEIP~-
DOES ti~TZLITY CONNECTION REQUIRE EXCAVATION IN PC'BLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSC~ED BY THE ENGZNEERING
~ NO DIVISION. LIST AS A CONDZTION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY: ~~~[~tv' ~~-o-t-c~zti,,~
TITLE:
DATE : C~// S~.F 7
~ ib
. ~ - CASH RECEIPT
~ "
~f CITY OF EAGAN
3830 PI~OT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 1 $
. ~
REGEIVED ~ •
FROM
AMOUNT ~ I
& DOLLIIR~
~ee
~ CASH ~ CHECK
FOR
FUND COD6 pMOUNT
Thank You
BY .y~:~-~~~
c~ White-Payers CopY
Yellow-Posting Copy
Pink-File Copy
I BLDG. PERMIT N0. % 4-"
, ~ ~ /J
.~""~`j
f ~ ~
~
s~-, s ~ ~
~ ~,~~lrr~~,- ; ~
01-3210 Bldg. Permit t ~ ' ~
01-3422 , Rlari 'CtSecic" ~ '
01-3445 Surch./Adm. ;
01-3446 SAC/Adm. "
01-2155 Surcharge -
17-386~ Road Unit -
20-2275 SAC ~
20-3865 Water Conn. ~
20-3868 Water Trmt.
20-3716 Water Meter % -
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
11-3855 Park Ded.
T~TAL ~ ~ %